MEDICARE: STEPHANIE A REDDICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	2021005776	MO
2	2085R0202X	Diagnostic Radiology Physician	036151862	IL
3	2085R0202X	Diagnostic Radiology Physician	32199	AZ
4	2085R0202X	Diagnostic Radiology Physician	290790	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00435435	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013096106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE A REDDICK M.D.

Provider Business Mailing Address
First Line	:	222 E 41ST ST FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6739
Country	:	US
Telephone Number	:	212-263-8868
Fax Number	:	212-263-2290

Provider Business Practice Location Address
First Line	:	6426 E SANTA AURELIA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85715-3128
Country	:	US
Telephone Number	:	877-276-9842
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	06/03/2026

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Directions to “ STEPHANIE A REDDICK M.D.” Practice Location

Language	Start Address	Practice Location

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